Indirect orthodontic bonding systems and methods for bracket placement

ABSTRACT

Systems and methods for fabricating indirect bonding trays are disclosed. Physical models of a patient&#39;s teeth can be created with non-functional placeholder brackets, impressions of which can be transferred to indirect bonding trays. This can create wells in which functional brackets can be placed into, reducing errors created from transferring functional brackets from the physical model onto the indirect bonding trays.

REFERENCE TO RELATED APPLICATIONS

This application claims the benefit under 35 U.S.C. § 119(e) as anon-provisional application of U.S. Prov. App. No. 62/429,664 filed onDec. 2, 2016, which is hereby incorporated by reference in its entirety.Any and all applications for which a foreign or domestic priority claimis identified in the Application Data Sheet as filed with the presentapplication are hereby incorporated by reference under 37 CFR 1.57.

BACKGROUND Field of the Invention

This invention relates, in some aspects, to improved indirect bondingsystems and methods for orthodontic bracket placement.

SUMMARY

In some embodiments, disclosed herein are methods for fabricating anindirect bonding tray for placement of orthodontic brackets. The methodscan involve, for example, providing a physical model of a patient'steeth. The model can include at least one non-functional placeholderorthodontic bracket attached to a tooth of the physical model. Amoldable material can be applied over the teeth and at least oneplaceholder bracket of the physical model, thereby creating an indirectbonding tray. The indirect bonding tray can include at least one wellcorresponding to the at least one non-functional placeholder bracket. Afunctional orthodontic bracket can be secured within each well of theindirect bonding tray. The functional orthodontic bracket can includethe same external geometry as the non-functional placeholder orthodonticbracket. The moldable material can be cured, and include, for example,polyvinyl siloxane. The model can be a malocclusion model in some cases.The indirect bonding tray can include a plurality of wells correspondingto a plurality of non-functional placeholder brackets. Thenon-functional placeholder brackets can include the same material asthat of the physical model. The non-functional placeholder brackets canbe fabricated as integral components of the physical model. The physicalmodel may be rapidly prototyped, such as by three-dimensional (3D)printing in some cases. The physical model may be fabricated accordingto information from a digital model. The digital modeling and the modelfabrication may be performed at remote locations from each other in someinstances. The model fabrication and indirect bonding (IDB) trayfabrication may be performed at remote locations from each other in someinstances.

Also disclosed herein, in some embodiments, is a method for placingorthodontic brackets onto teeth. The method can include providing anindirect bonding tray comprising wells comprising one or more functionalorthodontic brackets. The wells from the functional orthodontic bracketscan be created from impressions of non-functional placeholderorthodontic brackets comprising the same external geometry as thefunctional placeholder orthodontic brackets. The indirect bonding traycan be positioned in contact with a patient's teeth. The functionalorthodontic brackets can then be transferred from the indirect bondingtray to the patient's teeth.

Also disclosed herein is a system for use in fabricating an indirectbonding tray for placement of orthodontic brackets. The system caninclude a physical model of a patient's teeth. The model can include aplurality of non-functional placeholder orthodontic brackets attached toa tooth of the physical model. The non-functional placeholderorthodontic brackets can be permanently attached to respective teeth ofthe physical model, and as such cannot be transferred for use in thepatient's mouth. The non-functional placeholder orthodontic brackets canbe specifically configured (e.g., modified from the actual structure ofthe corresponding functional brackets) to optimize the fabrication(e.g., molding) of an indirect bonding tray to have wells that allowoptimal seating or placement of the functional brackets and/or thatfacilitate transfer of the brackets to a patient's teeth. For example,the placeholder brackets may be optimized by eliminating (e.g., theplaceholder brackets may not include) complex internal geometries (e.g.,undercuts) that are unnecessary for forming a negative impression thatholds and properly positions the functional orthodontic bracket. Inother words, the placeholder brackets could include, in someembodiments, only relatively smooth, continuous external surfaceswithout any undercuts.

In some embodiments, a method for fabricating an indirect bonding trayfor placement of orthodontic brackets is disclosed. The method includesproviding a physical model of a patient's teeth. The model has at leastone, two, or more non-functional placeholder orthodontic bracketsattached to a tooth of the physical model. The method further includesapplying a moldable material over the teeth and the at least oneplaceholder bracket of the physical model, thereby creating an indirectbonding tray. The indirect bonding tray has at least one wellcorresponding to the at least one non-functional placeholder bracket.The method further includes securing a functional orthodontic bracketwithin each well of the indirect bonding tray. The functionalorthodontic bracket has the same external geometry as the non-functionalplaceholder orthodontic bracket.

The method may include curing the moldable material. The moldablematerial may be or may include polyvinyl siloxane. The model may be amalocclusion model. The indirect bonding tray may include a plurality ofwells corresponding to a plurality of non-functional placeholderbrackets. The non-functional placeholder brackets may be the samematerial as that of the physical model.

The physical model may be fabricated from a digital model of thepatient's teeth. The method may include positioning digital brackets onthe digital model of the patient's teeth and modifying the geometry ofthe digital brackets while retaining the overall outline of the externalsurface of the digital brackets. Modifying the geometry of the digitalbrackets may include reducing or removing internal undercuts. Modifyingthe geometry of the digital brackets include removing internal detailsof the bracket. The method may include digitally moving the teeth frompositions of malocclusion to positions of ideal occlusion. The methodmay further include positioning digital brackets on surfaces of theteeth while in positions of malocclusion and restoring the teeth topositions of malocclusion while maintaining the positioning of thedigital brackets on the surfaces of the teeth.

The method may include applying a flexible membrane around the moldablematerial and shaping the moldable material into the shape of a dentalarch. The physical model may include instructive information indicativeof proper positioning of the indirect bonding tray on the patient'steeth and/or patient identification and the method may includetransferring the instructive information from the physical model to theindirect bonding tray. The method may include transferring instructiveinformation indicative of proper positioning of the indirect bondingtray on the patient's teeth and/or patient identification from anexternal tray positioned around the moldable material to the indirectbonding tray while the moldable material is moldable. Providing thephysical model may include 3D printing the physical model according to adigital model. The physical model may include support structures and themethod may include removing the support structures from the physicalmodel prior to applying the moldable material. The physical model caninclude at least one perforation between two teeth and the method caninclude sectioning the physical model along the perforation. Providingthe physical model may include fabricating the physical model such thatonly a subset of the patient's teeth corresponding to a segment of thepatient's dental arch are fabricated. The indirect bonding tray maycorrespond in size to the segment of the patient's dental arch.

In some embodiments, a method for placing orthodontic brackets ontoteeth is disclosed. The method includes providing an indirect bondingtray having wells. The wells contain a plurality of functionalorthodontic brackets. The wells were created from impressions ofnon-functional placeholder orthodontic brackets comprising the sameexternal geometry as the functional orthodontic brackets. The methodfurther includes positioning the indirect bonding tray in contact with apatient's teeth and transferring the functional orthodontic bracketsfrom the indirect bonding tray to the patient's teeth.

In some embodiments, a system for use in fabricating an indirect bondingtray for placement of orthodontic brackets is disclosed. The systemincludes a physical model of a patient's teeth. The model includes aplurality of non-functional placeholder orthodontic brackets attached toa plurality of teeth of the physical model. The non-functionalplaceholder orthodontic brackets are permanently attached to respectiveteeth of the physical model.

The system may include an indirect bonding tray formed as a negativeimpression of the physical model. The system may include a plurality offunctional orthodontic brackets, each functional orthodontic bracketcorresponding in external geometry to one of the plurality ofnon-functional placeholder orthodontic brackets.

Further features and advantages of various embodiments contemplated bythe present disclosure are described in detail below with reference tothe accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

These drawings are illustrative embodiments and do not present allpossible embodiments of this invention.

FIGS. 1A-1D schematically illustrate various non-limiting modificationsthat may be made to the external dimensions or geometry of a digitalbracket, according to one embodiment of the invention. FIGS. 1A and 1Bdepict side views of an example of a functional orthodontic bracket.FIGS. 1C and 1D illustrate the same views of the bracket as FIGS. 1A and1B, respectively, including schematic depictions of various possiblemodifications to the outline of the external surface or geometry of thebracket.

FIG. 2 illustrates a digital 3D print of a fabricated bonding model thatincludes non-functional placeholder brackets, according to someembodiments of the invention.

FIGS. 3A-3C illustrate the progressive fabrication of an indirectbonding tray, using polyvinyl siloxane and applying it over the bondingmodel and ensuring that all placeholder brackets are captured in theimpression, according to some embodiments of the invention.

FIGS. 4A-4C illustrate using poly wrap in the progressive fabrication ofan indirect bonding tray, creating a membrane such that the polyvinylsiloxane can be further molded into a desired arch shape, according tosome embodiments of the invention.

FIG. 5 illustrates the curing of an indirect bonding tray, by leavingthe tray at ambient room temperature for a desired curing time, such asbetween about 1-10 minutes, or about 3 minutes in some embodiments.

FIGS. 6A-6C illustrate the separation of the indirect bonding tray fromthe bonding model after curing has occurred, according to someembodiments of the invention.

FIG. 7 schematically depicts an occlusal view of the indirect bondingtray, according to some embodiments of the invention.

DETAILED DESCRIPTION

Indirect bonding (IDB) trays have been used in orthodontics to transferthe planned position of brackets from a digital or physical study modelto a patient's teeth. In a physical model, this has traditionally beendone by placing the functional brackets on a physical model (e.g.,outside of the patient) and then transferring the brackets to thepatient through an indirect bonding transfer tray technique.

Recently, this process has been improved by digitally planning theposition of brackets on a computer. This digital position of the bracketis then transferred to the patient through several methods. One methodis to print a jig or indirect bonding tray directly from the digitalworld which holds the information of the bracket position relative toeach tooth. The jig or indirect bonding tray would then be able todeliver a physical bracket to the patient in the digitally plannedposition. However, the ideal material for forming an indirect bondingtray may not be well-suited for precision fabrication of intricategeometries directly from a digital model. For instance, the idealindirect bonding tray may have a degree of elasticity, which may be lessrigid than ideal for convenient and rapid fabrication, such as by 3Dprinting. Another method is to print out a physical study model from thedigitally planned bracket position. This physical model that is printedfrom the digitally planned bracket position will usually have “wells” or“indentations” in the surface of the teeth allowing for placement of aphysical, functional bracket that is able to be bonded to a tooth andsecure an archwire. These physical, functional brackets can then bepicked up by an indirect bonding transfer tray and then delivered to thepatient through conventional methods. A drawback of this method, in somecases, is that there are often times human error in how the brackets areplaced on the physical model, which would propagate onto the indirectbonding tray and then to the patient. For example, the depth of thewells may alter the proper positioning of the functional brackets in theindirect bonding tray and/or if insufficiently deep may allow movementof the indirect bonding tray. Other methods may exist that are slightpermutations of the two methods mentioned above. Improved systems andmethods are needed.

In some embodiments, disclosed herein are improved systems and methodsof creating indirect bonding trays. This method can use in some casesdigital planning to place brackets in their correct position. Ratherthan printing out wells or indentations on a physical model to place theactual brackets, some embodiments create placeholder brackets, which arenot the actual physical brackets to be transferred to a patient's teeth,but rather a true outline of the physical brackets or a modified versionof the true outline, optimized for indirect transfer methods. Theplaceholder brackets are non-functional in some embodiments (e.g.,cannot secure an archwire), and in some cases can be integrally formedwith and not removable with respect to the physical model, such as byusing 3D printing or other techniques. In some embodiments, theplaceholder brackets lack extra undercut and internal details, but havethe same or substantially the same external geometry as their respectivefunctional orthodontic brackets. The placeholder brackets can, in someembodiments, be made of the same material as the physical model, and notbe made of any metal in some cases. A tray, such as an indirect bondingtray can then be created from this physical model with placeholderbrackets from the true actual outline of the physical brackets. Suchmethods can be advantageous in some cases in that the brackets can nowbe seated onto the indirect bonding tray directly, without requiringbeing picked up by a traditional “pick up method” in which thefunctional brackets are adhered to the physical model prior to beingtransferred to the indirect bonding tray. In other words, the functionalbrackets can be placed directly on the indirect bonding tray withoutrequiring them to be previously transferred from a physical model. Onepotential benefit is that because the physical brackets are not placedfor the first time until the indirect bonding tray is formed, there ispotentially less chance of errors, such as inaccurate placement ormovement of the brackets during the various steps, such as forming theindirect bonding tray. The brackets in the IDB tray can then betransferred to the teeth using a variety of bonding techniques.

In some embodiments, such methods can allow for easy transport of themodel which can now be transmitted digitally to the orthodontist orother health care provider enabling the fabrication of the IDB trayeither, for example, in a remote location (such as a manufacturingfacility) or at the chairside of a doctor who has a 3D printer in theiroffice. In some embodiments, it is not required that the entire IDB traybe printed for all the teeth. A partial/subset of an IDB tray can becreated for targeted placement of a set of brackets or properreplacement of a bracket when required, for example in the case of abracket that has debonded/come off the tooth, or in the case where thereis physical interference of the brackets in the malocclusion statepreventing the placement of one or more brackets in secondary step oncethe initial crowding that caused the interference has been resolved.

Some embodiments of methods for fabricating an in-office IDB tray willnow be disclosed. The methods can include, for example, any number ofthe following elements:

A doctor may take one or more malocclusion digital representations ofteeth. The digital representations may be obtained, for example, eitherfrom a direct intra-oral 3D digital scan of the teeth, a 3D scan of animpression of the teeth, or qv3D scan of a 3D model of patient's teeth.Any other method for obtaining an accurate 3D representation may be usedas well;

The malocclusion digital model may be sent, such as electronically(e.g., via the internet), through the internet to a lab;

The lab may isolate the teeth of the patient's malocclusion digitalmodel into individual teeth or groups of teeth. The lab may digitallymove the teeth into ideal occlusion positions;

The lab may position digital representations of orthodontic bracketsonto the digital ideal occlusion model;

The digital brackets may be modified representations of functionalorthodontic brackets. For instance, the digital brackets may representan outline of the 3D external geometry of a functional bracket. Forexample, the digital brackets may be modified to block out excessiveundercut and internal details of the functional bracket, leaving 3Dstructural outlines which will be referred to as placeholder brackets.

FIGS. 1A-1D schematically illustrate examples various non-limitingmodifications that may be made to the external dimensions or geometry ofa functional bracket. FIGS. 1A and 1B depict examples of functionalorthodontic brackets 100. FIG. 1A illustrates a side view of the bracket100 (e.g., a distal or medial view) and FIG. 1B illustrates anorthogonal side view (e.g., a gingival or occlusal view) of the bracket100. FIGS. 1C and 1D illustrate the same views of the bracket 100 asFIGS. 1A and 1B, respectively, including schematic depictions of variouspossible modifications 102 (depicted in dashed lines) to the outline ofthe external surface or geometry of the bracket 100. One or moremodifications 102 may be incorporated into a digital representation of aplaceholder bracket based on the functional bracket 100. Themodifications 102 may simplify the level of complexity of the externalgeometry of the bracket 100. For example, the archwire slot may beeliminated or reduced in dimension. The modifications 102 may bedesigned to optimize and/or simplify the fabrication of a negativeimpression (e.g., an IDB tray) of the placeholder bracket from aphysical model of the teeth with placeholder brackets. For instance, themodifications may eliminate (e.g., fill in) void volumes of the bracket100 which are unnecessary for, do not significantly facilitate, and/orconvolute the proper placement and/or retention of a functional bracket100 in an IDB tray. For example, geometries which would result in verythin and/or flimsy projections protruding from an internal surface of awell in the IDB tray may provide little or no structural support and/orlittle or no positioning guidance for the functional bracket 100,particularly depending on the physical properties of the material fromwhich the IDB tray is fabricated. In some implementations, the geometrymay be modified to facilitate transfer of the functional brackets 100 tothe patient's teeth. For example, the geometry may be modified such thatthe IDB tray may more easily be retracted or withdrawn from thepatient's teeth without excessively clinging to the bonded functionalbrackets 100. The IDB tray may have a degree of deformability thatallows the tray to be removed from brackets 100 after they have bondedto the patient's teeth. The geometry of the placeholder brackets may bemodified to optimize retention of the functional brackets 100 in the IDBtray (e.g., during movement such as transfer to the patient's mouth) aswell as release of the IDB tray from the functional brackets 100 afterbonding. The modifications 102 may include reangling of portions of theouter geometry, eliminating or reducing the dimensions of undercuts,etc. In some embodiments, the external geometry of the placeholderbrackets may be additionally or alternatively expanded beyond the truedimensions of the functional bracket 100;

The lab may replace the digital brackets with digital placeholderbrackets. The digital placeholder brackets can be placed in the sameexact position, or substantially similar location, as the digitalbrackets. The true outline of the bracket interface with the individualtooth may be preserved to ensure proper alignment of the functionalbracket 100 with the patient's tooth during transfer;

The digital teeth and placeholder brackets of the ideal occlusion modelmay be moved back onto the malocclusion digital model. The digitalplaceholder bracket position relative to the tooth may be maintained asthe teeth are repositioned from a state of ideal occlusion back tooriginal state of malocclusion;

The digital placeholder brackets and the malocclusion digital model canbe combined into a single file for each arch;

Supports may be added to the model to aid in rapid prototyping. Thesupports can facilitate fabrication of the physical model and/orhandling of the physical model. For instance the supports may providestructural support to the physical model during fabrication;

Digital perforations may be added between one or more teeth. Theseperforations would allow the clinician to snap off individual teeth orgroups of teeth to make sectional indirect bonding (IDB) trays;

The lab may rapid prototype this final digital model that includes themalocclusion digital model with placeholder brackets and supports into aphysical model. Alternatively, the lab may send the final digital modelto the doctor (e.g., electronically send via the internet) to allowdirect fabrication by the doctor. FIG. 2 depicts an image of a physicalmodel 200 of a patient's teeth including placeholder brackets 202. Theplaceholder brackets 202 may be formed as an integral part of the model200 during fabrication of the model 200. In some embodiments, theplaceholder brackets may be simplified down to a generally cubicrepresentation of the functional orthodontic bracket. Fabrication of thephysical model may be performed by a rapid prototyping means, such as 3Dprinting, or any other suitable means known in the art. In someembodiments, the physical model may comprise the entire set, or only asubset of the patient's teeth. The subset of teeth may correspond to asegment of the dental arch. The physical model may correspond in size(e.g., the length the tray extends along the dental arch) to the segmentof the dental arch or may correspond to the entire arch but may notinclude teeth not selected as part of the subset;

Any added supports may be removed from the rapid prototyped model asnecessary. The supports may be fabricated (e.g., with reduce crosssections) such that they allow easy and precise breakage of the supportfrom the remainder of the model with application of a sufficient amountof manual force. The supports can also be kept to be used as handles tohold the physical model 200 for later processes;

If the lab produces the physical model, the lab may either proceed withmaking the IDB tray, or the lab may mail the rapid prototyped model tothe doctor to allow the doctor to make the IDB tray;

The IDB tray can be formed by applying polyvinyl siloxane (PVS) or otherimpression-forming moldable material, over the rapid prototyped modelcovering the placeholder brackets and all or selected surfaces of theteeth. FIGS. 3A-3C illustrate images of the progressive application of amoldable material 204 (e.g., PVS) to the physical model 200. As shown inFIGS. 3A-3C, the moldable material may be injected onto the physicalmodel 200 using a delivery device 250 having an application tip 252. Anyother suitable application means may be used as well. The placeholderbrackets 202 from the rapid prototyped model can create the wells thatthe orthodontic brackets 100 can be placed into on the IDB tray. Inembodiments where the physical model comprises only a segment of thepatients' dental arch, the moldable material 204 may be applied onlyover the segment (which may comprise the entire physical model) suchthat an IDB tray corresponding in size to only the segment is formed.Alternatively, the moldable material 204 may be applied to only a selectsubset of teeth to form one or more IDB trays corresponding in size toone or more segments of the dental arch. Partial IDB trays may be usefulfor performing bracket replacements and/or for subsequent placement ofbrackets that were initially infeasible to place (e.g., due to physicalinterference such as overcrowding) as described elsewhere herein;

While the moldable material 204 is still moldable, the moldable material204 can be molded into the desired arch form. In some embodiments, aflexible membrane 210 may be used to facilitate the molding of themoldable material 204 into the IDB tray. In some embodiments, themembrane may comprise polyethylene (e.g., poly wrap). The membrane 210can facilitate retaining the somewhat fluidic moldable material 204 intoa desired geometry around the physical model 200 while allowing theclinician to bend and shape the moldable material 204 into the desiredform. FIGS. 4A-4C illustrate images of the use of a membrane toprogressively shape the applied moldable material 204 around thephysical model 200 into a desired arch form. The membrane 210 may beparticularly useful for shaping the outer surface of the IDB tray;

The moldable material 204 may be cured after shaping. The moldablematerial 204 may automatically cure over time upon application. FIG. 5illustrates curing of the moldable material 204 to form a solid IDB trayaround the physical model 200. For example, PVS may cure by leaving thePVS material at ambient room temperature for a period of several minutes(e.g., 1-10 minutes, or more or less). In some embodiments, the PVS maybe adequately cured after about 3, 4, 5, 6, 7, 8, 9, or 10 minutes, orranges including any two of the aforementioned values. In someembodiments, application of heat and/or light may be used to cure or tofacilitate curing the impression material;

The moldable material 204 can be removed from the rapid prototyped modelafter curing is complete yielding an IDB tray 300 which can be used forindirect bonding of orthodontic brackets. FIG. 6A illustrates an imageof the separated IDB tray 300 and the physical model 200, after curingof the moldable material has occurred. FIGS. 6B and 6C depict theseparated physical model 200 and IDB tray 300, respectively. FIG. 7schematically depicts an occlusal view of the IDB tray 300. The IDB tray300 may be formed as a negative impression of the physical model 200which includes placeholder brackets 202. The IDB tray 300 may includewells 302 for fitting to a patient's teeth as well as wells 304 forreceiving one or more functional orthodontic brackets 100 to betransferred to the patient's teeth. The wells 302 of the teeth may mergewith each other. Each dental arch may essentially form one large well ora plurality of wells larger than individual teeth. The wells 304 mayalso merge into the wells 302 of the teeth. The wells 304 may be formedto match the external outline or geometry of the functional brackets 100based on the digitally modified placeholder brackets 202. The bracketwells 304 may cause the teeth wells 302 to extend deeper into theimpression material of the IDB tray 300, such as in an occlusal and/orlingual direction. Although the brackets 100 depicted herein aredepicted as lingual orthodontic brackets, the methods and systemsdescribed herein may be equally applied to other arrangements oforthodontic devices, including buccal orthodontic brackets;

The lab or doctor may place the functional brackets 100 securely insidethe bracket wells 304 in the IDB tray 300 with the bonding side of thebrackets facing outward away from the impression material of the IDBtray and toward the open well 302 conformed to receive the patient'steeth;

Adhesives may be added on the bonding side of the IDB tray 300.Adhesives may be added to the brackets 100 after all the brackets areproperly placed in the IDB tray 300 in some cases. The adhesives may becured or partially cured prior to transferring the tray and/or duringapplication of the IDB tray 300 to the patient's teeth. After allowingsufficient time for the functional brackets 100 to securely bond to thepatient's teeth, the IDB tray 300 may be removed from the patient'smouth leaving the functional brackets 100 in place on the patient'steeth; and

If the lab made the IDB tray 300, the lab can mail or otherwise send theIDB tray 300 pre-loaded with brackets 100 and optionally the rapidprototyped model 200 to the doctor;

Alternatively, the IDB tray 300 can be sent to the orthodontic officeallowing the office to load the brackets 100 into the IDB tray 200.

A wide range of impression materials is available for taking dentalimpressions, such as to form the IDB tray 200. The major chemicalclasses of elastomeric impression materials include irreversiblehydrocolloids, reversible hydrocolloids, polysulfide, polyether,condensation reaction silicones and addition reaction silicones.Alginates are examples of irreversible hydrocolloids formed by combiningthe sodium salt of alginic acid, calcium sulfate and water. Commerciallyavailable alginate impression materials include Jeltrate®(Dentsply/Caulk), Coe Alginate® (Coe) and Kromopan® (Lascod S.p.A.).Polyethers come as a two part system consisting of base and catalystpastes. The base contains a polyether with imine end groups and thecatalyst contains an aromatic sulfonic acid. These components may beeither mixed by hand or dispensed from a dual chambered cartridge thatautomatically mixes the correct proportions of base and catalystmaterial. Commercially available polyether materials include Impregum F®(ESPE), Permadyne® (ESPE) and Polyjel® (Dentsply/Caulk). Likepolyethers, addition reaction silicones are a two part system consistingof base and catalyst pastes. These materials are also calledpolyvinylsiloxanes or vinyl siloxanes since vinyl groups are present asterminal end groups in one paste. The other paste contains terminalhydrogens. When mixed together they form a highly cross-linkedelastomeric material which recovers well from deformation. Commerciallyavailable PVS impression materials include Splash® (Discus Dental),Aquasil® (Dentsply/Caulk) and Dimension® (ESPE). Depending on theradiopacity of the tray and impression materials in some applications itmay be useful to directly compound a radiopaque material into theimpression material to achieve a desired attenuation. The radiopaquematerial may be formulated into the impression materials describedpreviously.

In some embodiments, the IDB tray 300 may comprise indicia, includinginstructional information printed or otherwise marked on the tray 300.The information may comprise, for example, identification markers thatinclude, for instance, information relevant to placing the proper trayin the proper location on the correct patient's teeth (e.g., toothnumber position, upper or lower arch indicator, patient number, etc.).In some cases, the information may be transferred from the physicalmodel 200 to the interior surface of the indirect bonding tray 200. Forexample, the physical model 300 may be modified with a relief,embossment, stamp, indentation, etc. of text or other markingsindicative of the information. The information may be positioned, forexample, in a tooth well such that it can be seen even after placementof the functional orthodontic brackets 100. The information may be sized(e.g., in area and/or depth) such that it does not significantly alternegative impression and, therefore, does not interfere with the properfitting of the IDB tray 300 to the patient's teeth. In some cases, thecorresponding wells of the indirect bonding tray may be colored (e.g.,with an agent, ink, or paint) to make the information more readilyvisible. For example, the colored agent, ink, or paint may fill anindentation in the IDB tray 300 before drying such that it makes theinformation stand out. Residual agent, ink, or dye may be wiped cleanform the surface of the IDB tray 300. Additionally or alternatively,information may be transferred to an external surface of the indirectbonding tray by molding the IDB tray 300 with an additional externaltray which shapes the outer surface of the IDB tray 300. In someembodiments, the information may be directly transferred onto the IDBtray 300. For example, the information may be written on the tray or amarker comprising the information may be attached to the tray IDB tray300. In some embodiments, the information may be in non-textual form.For example, the information may be a color or fiduciary marker. In someembodiments, the information can be contained within a barcode, passiveor active RFID tag, or other elements that can be positioned in variouslocations similar to the indicia noted above.

Various other modifications, adaptations, and alternative designs are ofcourse possible in light of the above teachings. For example, featuresincluding brackets disclosed in U.S. Pub. No. 2014/0120491 A1 toKhoshnevis et al., hereby incorporated by reference in its entirety, canbe utilized or modified or use with embodiments as disclosed herein.Therefore, it should be understood at this time that within the scope ofthe appended claims the invention may be practiced otherwise than asspecifically described herein. It is contemplated that variouscombinations or subcombinations of the specific features and aspects ofthe embodiments disclosed above may be made and still fall within one ormore of the inventions. Further, the disclosure herein of any particularfeature, aspect, method, property, characteristic, quality, attribute,element, or the like in connection with an embodiment can be used in allother embodiments set forth herein. Accordingly, it should be understoodthat various features and aspects of the disclosed embodiments can becombined with or substituted for one another in order to form varyingmodes of the disclosed inventions. Thus, it is intended that the scopeof the present inventions herein disclosed should not be limited by theparticular disclosed embodiments described above. Moreover, while theinvention is susceptible to various modifications, and alternativeforms, specific examples thereof have been shown in the drawings and areherein described in detail. It should be understood, however, that theinvention is not to be limited to the particular forms or methodsdisclosed, but to the contrary, the invention is to cover allmodifications, equivalents, and alternatives falling within the spiritand scope of the various embodiments described and the appended claims.Any methods disclosed herein need not be performed in the order recited.The methods disclosed herein include certain actions taken by apractitioner; however, they can also include any third-party instructionof those actions, either expressly or by implication. For example,actions such as “transferring an orthodontic bracket” includes“instructing the transferring of an orthodontic bracket.” The rangesdisclosed herein also encompass any and all overlap, sub-ranges, andcombinations thereof. Language such as “up to,” “at least,” “greaterthan,” “less than,” “between,” and the like includes the number recited.Numbers preceded by a term such as “approximately”, “about”, and“substantially” as used herein include the recited numbers (e.g., about10%=10%), and also represent an amount close to the stated amount thatstill performs a desired function or achieves a desired result. Forexample, the terms “approximately”, “about”, and “substantially” mayrefer to an amount that is within less than 10% of, within less than 5%of, within less than 1% of, within less than 0.1% of, and within lessthan 0.01% of the stated amount.

What is claimed is:
 1. A method for fabricating an indirect bonding trayfor placement of orthodontic brackets, comprising: providing a physicalmodel of a patient's teeth, the model comprising at least onenon-functional placeholder orthodontic bracket attached to a tooth ofthe physical model; applying a moldable material over the teeth and theat least one placeholder bracket of the physical model, thereby creatingan indirect bonding tray, the indirect bonding tray comprising at leastone well corresponding to the at least one non-functional placeholderbracket; and securing a functional orthodontic bracket within each wellof the indirect bonding tray, the functional orthodontic bracketcomprising the same external geometry as the non-functional placeholderorthodontic bracket.
 2. The method of claim 1, further comprising curingthe moldable material.
 3. The method of claim 1, wherein the moldablematerial comprises polyvinyl siloxane.
 4. The method of claim 1, whereinthe model is a malocclusion model.
 5. The method of claim 1, wherein theindirect bonding tray comprises a plurality of wells corresponding to aplurality of non-functional placeholder brackets.
 6. The method of claim1, wherein the non-functional placeholder brackets comprise the samematerial as that of the physical model.
 7. The method of claim 1,wherein the physical model is fabricated from a digital model of thepatient's teeth, the method further comprising: positioning digitalbrackets on the digital model of the patient's teeth; and modifying thegeometry of the digital brackets while retaining the overall outline ofthe external surface of the digital brackets.
 8. The method of claim 7,wherein modifying the geometry of the digital brackets comprisesreducing or removing internal undercuts.
 9. The method of claim 7,wherein modifying the geometry of the digital brackets comprisesremoving internal details of the bracket.
 10. The method of claim 1,wherein the physical model is fabricated from a digital model of thepatient's teeth, the method further comprising: digitally moving theteeth from positions of malocclusion to positions of ideal occlusion;positioning digital brackets on surfaces of the teeth while in positionsof malocclusion; and restoring the teeth to positions of malocclusionwhile maintaining the positioning of the digital brackets on thesurfaces of the teeth.
 11. The method of claim 1, further comprisingapplying a flexible membrane around the moldable material and shapingthe moldable material into the shape of a dental arch.
 12. The method ofclaim 1, wherein the physical model includes instructive informationindicative of proper positioning of the indirect bonding tray on thepatient's teeth and/or patient identification, the method furthercomprising transferring the instructive information from the physicalmodel to the indirect bonding tray.
 13. The method of claim 1, furthercomprising transferring instructive information indicative of properpositioning of the indirect bonding tray on the patient's teeth and/orpatient identification from an external tray positioned around themoldable material to the indirect bonding tray while the moldablematerial is moldable.
 14. The method of claim 1, wherein providing thephysical model comprises 3D printing the physical model according to adigital model.
 15. The method of claim 1, wherein the physical modelcomprises support structures, the method further comprising removing thesupport structures from the physical model prior to applying themoldable material.
 16. The method of claim 1, wherein the physical modelcomprises at least one perforation between two teeth, the method furthercomprising sectioning the physical model along the perforation.
 17. Themethod of claim 1, wherein providing the physical model comprisesfabricating the physical model such that only a subset of the patient'steeth corresponding to a segment of the patient's dental arch arefabricated and wherein the indirect bonding tray corresponds in size tothe segment of the patient's dental arch.
 18. A method for placingorthodontic brackets onto teeth, comprising: providing an indirectbonding tray comprising wells comprising a plurality of functionalorthodontic brackets, wherein the wells were created from impressions ofnon-functional placeholder orthodontic brackets comprising the sameexternal geometry as the functional orthodontic brackets; positioningthe indirect bonding tray in contact with a patient's teeth; andtransferring the functional orthodontic brackets from the indirectbonding tray to the patient's teeth.
 19. A system for use in fabricatingan indirect bonding tray for placement of orthodontic brackets,comprising: a physical model of a patient's teeth, the model comprisinga plurality of non-functional placeholder orthodontic brackets attachedto a plurality of teeth of the physical model, the non-functionalplaceholder orthodontic brackets permanently attached to respectiveteeth of the physical model.
 20. The system of claim 19, furthercomprising an indirect bonding tray formed as a negative impression ofthe physical model.
 21. The system of claim 19, further comprising aplurality of functional orthodontic brackets, each functionalorthodontic bracket corresponding in external geometry to one of theplurality of non-functional placeholder orthodontic brackets.